Obinutuzumab (Anti-CD20 — Lupus Nephritis)

How it works

It binds CD20 on B lymphocytes and triggers profound B-cell depletion predominantly through direct cell death and antibody-dependent cellular cytotoxicity, with comparatively less complement-dependent cytotoxicity than type I anti-CD20 agents.

Prescribing in practice

• Screen for hepatitis B (HBsAg and anti-HBc) before treatment because B-cell depletion can reactivate hepatitis B, sometimes fulminant — withhold in active infection and arrange specialist monitoring/prophylaxis for past exposure.
• Infusion-related reactions are common, particularly with the first infusion, so give premedication and infuse with appropriate monitoring and resuscitation facilities available.
• Prolonged B-cell depletion increases infection risk, including the rare possibility of progressive multifocal leukoencephalopathy, so investigate new neurological or persistent infective symptoms promptly.

Monitoring

Monitor full blood count for cytopenias, watch for infection and infusion reactions, and remain alert to hepatitis B reactivation and new neurological signs throughout and after the treatment course.

Counselling the patient

• Report fever, sore throat or other signs of infection without delay.
• Tell us about any new confusion, weakness or changes in vision.
• Live vaccines should be avoided while your B cells are suppressed.

Evidence & guidelines

Use in lupus nephritis is supported by controlled trial data showing improved renal responses when added to standard care, though it remains a specialist-initiated, off-label or emerging indication in the UK.